局灶性皮层发育不良致儿童难治性癫痫的病理分型及术后疗效分析  

Pathological classification and postoperative outcome in children with focal cortical dysplasia-related refractory epilepsy

作　　者：董长征[1] 康进生[1] 赵磊[1] 张波[1] 马万东 刘晓辉 DONG Chang-zheng;KANG Jin-sheng;ZHAO Lei;ZHANG Bo;MA Wan-dong;LIU Xiao-hui(The Second Department of Neurosurgery,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院神经外二科,河北石家庄050051

出　　处：《河北医科大学学报》2018年第12期1394-1397,1402,共5页Journal of Hebei Medical University

基　　金：河北省科技计划项目(13277767D)

摘　　要：目的探讨局灶性皮层发育不良(focal cortical dysplasia,FCD)致儿童难治性癫痫患者的病理分型及术后疗效,并分析影响手术疗效的相关因素。方法选择儿童难治性癫痫手术患者86例,按照2011年国际抗癫痫联盟(International League Against Epilepsy,ILAE)FCD的分型标准分为2型:单纯型FCD(FCDⅠ、Ⅱ型)和结合型FCD(FCDⅢ型)。按照ILAE的Engel标准对术后疗效进行判断,根据术后疗效又分为预后良好组和预后不良组,运用统计学软件分析影响手术预后的相关因素。结果 86例患者病理结果:单纯型FCD 37例,其中FCDⅠ型19例,FCDⅡ型18例;结合型FCD(FCDⅢ型)49例。86例癫痫患者中EngelⅠ级57例,EngelⅡ级16例,EngelⅢ级10例,EngelⅣ级3例。术后总有效率为66.3%,其中单纯型FCD术后有效率为20.9%,结合型FCD为45.3%。与预后不良组比较,预后良好组中结合型FCD、致痫灶位于颞叶、致痫灶未邻近功能区、头颅MRI阳性、视频脑电图显示局灶性放电、完整切除致痫灶的患者较多,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,致痫灶切除范围是影响FCD所致儿童难治性癫痫手术疗效的独立预后因素。结论完整切除颅内致痫灶是提高FCD致儿童难治性癫痫术后疗效的关键因素。Objective To investigate the pathological classification and postoperative outcome in children with refractory epilepsy induced by focal cortical dysplasia（FCD）and analyze the related factors affecting the surgical efficacy.Methods Eighty-six children with refractory epilepsy undergoing surgery were selected.The excision specimens were classified according to the FCD classification criteria in 2011 International League Against Epilepsy（ILAE）,and the postoperative outcome was also judged according to the ILAE Engel criteria.ResultsPathological results of 86 patients：Simplex FCD 37 cases,of which the FCD Ⅰ19 cases,FCD Ⅱtype 18 cases;Combining FCD（FCD Ⅲ type）in 49 cases.86 patients with epilepsy in Engel grade I 57 cases,EngelⅡlevel 16 cases,EngelⅢlevel 10 cases,Engel levelⅣ（3 cases）.The total effective rate after operation was 66.3%,of which 20.9% was after FCD alone.The combined FCD is 45.3%.Compared with the group with poor prognosis,there were more patients in the group with good prognosis who had combined type FCD,epileptic focus located in temporal lobe,epileptic focus without adjacent functional area,positive cranial MRI,video eeg showing focal discharge and complete removal of epileptic focus（P〈0.05）.The results of Logistic regression analysis showed that the range of eclampsia excision was an independent prognostic factor affecting the efficacy of pediatric refractory epilepsy surgery caused by FCD.Conclusion Complete removal of intracranial epileptic foci is a key factor to improve the postoperative efficacy of children with refractory epilepsy caused by FCD.

关 键 词：癫痫 局灶性皮层发育不良 儿童 

分 类 号：R742.1[医药卫生—神经病学与精神病学]